Case Report: Pediatric B-cell acute lymphoblastic leukemia presenting with recurrent seizures and persistent peripheral blood blast negativity
- 1Department of Clinical Laboratory, Shenzhen Children's Hospital, Affiliated with Shantou University Medical College, Shenzhen, Guangdong, China
- 2Department of Clinical Laboratory Medicine, The People’s Hospital of Longhua, Shenzhen, Guangdong, China
Abstract
BackgroundCentral nervous system-predominant pediatric B-cell acute lymphoblastic leukemia (B-ALL) may present without peripheral blood abnormalities, and corticosteroid exposure can cause false-negative CSF cytomorphology.Case presentationA 5-year-and-7-month-old boy presented with recurrent seizures and cranial nerve deficits. Initial peripheral blood smears and CSF examinations were blast-negative. The interval between symptom onset and definitive diagnosis was 8 months; whether early symptoms were leukemia-attributable remains uncertain. In December 2019, repeated lumbar puncture revealed CSF pleocytosis (89 × 106/L) with suspicious blasts. Bone marrow showed 81.5% blasts; flow cytometry confirmed B-lymphoid phenotype. CSF flow cytometry confirmed CNS3 status. KRAS G12 V (10.2% VAF) was detected. Peripheral blood remained blast-negative throughout. He achieved complete remission (morphological blasts <5%; MRD <0.01%) on the CCCG-ALL-2015 HR protocol. In March 2021, he developed isolated bone marrow relapse (morphological blasts 56%; MRD 50%) with negative CSF. Sequential CD19/CD22 CAR T therapy induced sustained remission. At the last follow-up (52 months post-CAR T), MRD remained below detection.ConclusionsCNS-predominant B-ALL may present with recurrent seizures despite normal peripheral blood. Repeated CSF analysis and flow cytometry are essential when cytomorphology is negative. Sequential CD19/CD22 CAR T achieved durable remission in relapsed B-ALL with prior CNS involvement.
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BibTeX
@article{cao2026case,
title = {{Case Report: Pediatric B-cell acute lymphoblastic leukemia presenting with recurrent seizures and persistent peripheral blood blast negativity}},
author = {Ke Cao and Yan Zhang and Xiaojuan Luo and Xueyan Chen},
journal = {Frontiers in Pediatrics},
year = {2026},
month = nov,
doi = {10.3389/fped.2026.1996188},
url = {https://doi.org/10.3389/fped.2026.1996188},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Pediatric B-cell acute lymphoblastic leukemia presenting with recurrent seizures and persistent peripheral blood blast negativity
AU - Ke Cao
AU - Yan Zhang
AU - Xiaojuan Luo
AU - Xueyan Chen
PY - 2026
DA - 2026/11/12
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1996188
UR - https://doi.org/10.3389/fped.2026.1996188
AB - BackgroundCentral nervous system-predominant pediatric B-cell acute lymphoblastic leukemia (B-ALL) may present without peripheral blood abnormalities, and corticosteroid exposure can cause false-negative CSF cytomorphology.Case presentationA 5-year-and-7-month-old boy presented with recurrent seizures and cranial nerve deficits. Initial peripheral blood smears and CSF examinations were blast-negative. The interval between symptom onset and definitive diagnosis was 8 months; whether early symptoms were leukemia-attributable remains uncertain. In December 2019, repeated lumbar puncture revealed CSF pleocytosis (89 × 106/L) with suspicious blasts. Bone marrow showed 81.5% blasts; flow cytometry confirmed B-lymphoid phenotype. CSF flow cytometry confirmed CNS3 status. KRAS G12 V (10.2% VAF) was detected. Peripheral blood remained blast-negative throughout. He achieved complete remission (morphological blasts <5%; MRD <0.01%) on the CCCG-ALL-2015 HR protocol. In March 2021, he developed isolated bone marrow relapse (morphological blasts 56%; MRD 50%) with negative CSF. Sequential CD19/CD22 CAR T therapy induced sustained remission. At the last follow-up (52 months post-CAR T), MRD remained below detection.ConclusionsCNS-predominant B-ALL may present with recurrent seizures despite normal peripheral blood. Repeated CSF analysis and flow cytometry are essential when cytomorphology is negative. Sequential CD19/CD22 CAR T achieved durable remission in relapsed B-ALL with prior CNS involvement.
SN - 2296-2360
ER -